Ueyama K, Kakinuma T, Mori K, Hayashi A, Kakinuma K, Okamoto R, Kaneko A, Yanagida K, Takeshima N, Ohwada M. Managing Vogt–Koyanagi–Harada disease during pregnancy with steroid pulse therapy: A case report. World J Clin Cases 2024; 12(31): 6493-6499 [PMID: 39507109 DOI: 10.12998/wjcc.v12.i31.6493]
Corresponding Author of This Article
Toshiyuki Kakinuma, MD, PhD, Professor, Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Tochigi 329-2763, Nasushiobara, Japan. tokakinuma@gmail.com
Research Domain of This Article
Obstetrics & Gynecology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Kyouhei Ueyama, Toshiyuki Kakinuma, Kaoru Kakinuma, Rora Okamoto, Ayaka Kaneko, Kaoru Yanagida, Nobuhiro Takeshima, Michitaka Ohwada, Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Nasushiobara, Japan
Keisuke Mori, Ayumi Hayashi, Department of Ophthalmology, International University of Health and Welfare Hospital, Tochigi 327-2763, Japan
Author contributions: Ueyama K and Kakinuma T designed the research study; All authors performed the research; Ueyama K and Kakinuma T analyzed the data and wrote the manuscript; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Toshiyuki Kakinuma, MD, PhD, Professor, Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, 537-3, Iguchi, Tochigi 329-2763, Nasushiobara, Japan. tokakinuma@gmail.com
Received: May 9, 2024 Revised: August 22, 2024 Accepted: August 28, 2024 Published online: November 6, 2024 Processing time: 124 Days and 18.7 Hours
Abstract
BACKGROUND
High-dose steroid administration is a common initial therapeutic approach for Vogt–Koyanagi–Harada disease (VKH). Nonetheless, administering substantial doses of steroids to pregnant women necessitates meticulous consideration due to the potential impacts on the mother and fetus. We present a case wherein steroid pulse therapy was administered to a patient who developed VKH during the late stages of pregnancy.
CASE SUMMARY
The patient was a 26-year-old nulliparous woman. At 33 weeks and 1 day of her pregnancy, she experienced a decline in visual acuity and noticed metamorphopsia in her left eye. Examination revealed bilateral serous retinal detachment, leading to VKH diagnosis. A collaborative effort involving the departments of ophthalmology, internal medicine, and neonatology was initiated. Steroid pulse therapy was administered at 34 weeks and 1 day of pregnancy under hospital supervision. Complications, such as threatened preterm labor and gestational diabetes, emerged, necessitating the initiation of oral ritodrine hydrochloride and insulin therapy. Then, serous retinal detachment was resolved, and visual acuity was restored. Labor pains initiated 32 days post-initiation of steroid pulse therapy (at 38 weeks and 4 days of gestation), culminating in a normal delivery. Mother and newborn experienced an uneventful puerperal course and were discharged from the hospital on the 5th day following delivery.
CONCLUSION
VKH management in pregnancy requires multidisciplinary coordination, emphasizing collaboration with ophthalmologists and specialists in internal medicine and neonatology.
Core Tip: Generally, high-dose steroid administration is the initial treatment for Vogt–Koyanagi–Harada disease (VKH). However, administering large doses of steroids to pregnant women requires careful treatment, considering their effects on the mother and fetus. We report a case in which steroid pulse therapy was administered to a patient who developed VKH during late pregnancy, and multidisciplinary management led to normal delivery. When treating VKH that develops during pregnancy, multidisciplinary management is considered necessary, with close collaboration not only with ophthalmologists, but also internal medicine and neonatologists.
